Teaching a patient who can't read

ChristineN, BSN, RN · Feb 18, 2006

I don't know what type of dietary info you're looking for, but my nutrition instructor told us the exchange guide is available in pictures for those who can't read. It's published by the American Diabetes Association. :)

UM Review RN, ASN, RN · Feb 18, 2006

You might also try here:

http://www.literacyvolunteers.org/

I know of a couple of successful adults who were functional illiterates. One man turned out to be a dyslexic. The other had quit school at a very early age, and when he was in his late forties, decided to learn how to read. He and his wife would read aloud to each other and he really enjoyed mastering the written word.

NephroBSN, BSN, RN · Feb 18, 2006

Thanks to all for your help.

grannynurse FNP student · Feb 18, 2006

Hello all,
I recently realized one of my dialysis patients couldn't read. I was surprised. Can anyone direct me to educational material for those who can't read. I need dietary information the most.
Also, can anyone direct me to research or papers written on the subject of an adult who can't read. I would like to write a journal article on the subject.
Thanks in advance for your help

I do not know if your unit is a free standing one or connected to a facility. Check with your registered dietician, if one is available. They have access to photos and easily understood plates, cups and plastic foods to demonstrate amounts. Also you might want to refer your patient to the Literacy Council that offers free help with learning to read for adults. As for your research, go to Medline and/or CINHAL(?) and type in key works literacy, impact on health. You will find sufficent information.

Grannynurse

NephroBSN, BSN, RN · Feb 19, 2006

I do not know if your unit is a free standing one or connected to a facility. Check with your registered dietician, if one is available. They have access to photos and easily understood plates, cups and plastic foods to demonstrate amounts. Also you might want to refer your patient to the Literacy Council that offers free help with learning to read for adults. As for your research, go to Medline and/or CINHAL(?) and type in key works literacy, impact on health. You will find sufficent information.
Grannynurse

Thanks this lady is in her 70's I don't believe she's gonna learn to read and she's too proud. I don't want to change her I want to help her. We do have a dietician. But I want to reinforce things.

Thanks for the info on Medline and Cinhal. I was aware of them. I just thought someone might have a first hand experience they might be willing to share.

VickyRN, MSN, DNP, RN · Feb 25, 2006

Hello all,
I recently realized one of my dialysis patients couldn't read. I was surprised. Can anyone direct me to educational material for those who can't read. I need dietary information the most.
Also, can anyone direct me to research or papers written on the subject of an adult who can't read. I would like to write a journal article on the subject.
Thanks in advance for your help

Possible "leads" on resources:

Teaching Patients With Low Literacy Skills

Issues in Patient Education

grannynurse FNP student · Feb 25, 2006

Thanks this lady is in her 70's I don't believe she's gonna learn to read and she's too proud. I don't want to change her I want to help her. We do have a dietician. But I want to reinforce things.
Thanks for the info on Medline and Cinhal. I was aware of them. I just thought someone might have a first hand experience they might be willing to share.

I once had a patient who was functionally illiterate and was 80. I spoke to him about learning to read, even at his age, and he agreed it was something he had always wanted to learn. But he allowed his pride to stop him from learning. It takes a very careful approach to refer someone who has been unable to read for a life time. But you would be surprised at the desire, once it is awakened.

Grannynurse

Beth's granddaughter · Mar 13, 2006

I speak Spanish and often served as a medical interpreter. We had a young mother from Mexico whose prematurely born daughter (then about 2 months old) was suffering from pneumonia. The nurse "caught" mom propping the bottle to feed her baby. The formula was being aspirated because baby's swallow was not strong and she could not roll over and get away from the steady drip of the bottle. I was called in to interpret as the primary care nurse did some teaching. I brought lots of literature with me about holding baby when feeding, the dangers of bottle-propping... and it was all in Spanish, too. I interpreted for the nurse, and as we left, I asked the patient to read the pamphlets. Guess what? The respiratory therapist caught her propping the bottle again later that night. This time the baby crashed, and we eventually sent her via life-flight to a Children's hospital in the north of the state. (We were a small rural hospital). In talking to the mom as we prepared baby for the flight, I discovered she was illiterate - she couldn't even read her native language. I don't think I ever failed a patient more miserably in my patient teaching. The mom was very young - a teenager, who already had two other toddlers. She was in a foreign country, away from her support system of mom, grandmas, sisters, cousins, friends who spoke her language, away from traditions, frightened for her sick and fragile little baby and afraid to hold her, living in poverty, worried about her toddlers, fearful because she and her husband were illegal and didn't want to be deported... and here were these nurses shaking their finger at her and telling her things she didn't understand, using big words (Spanish words, but still big words), and whisking her baby away to a helicopter to be taken 250 miles away.

I tell this story to my students when we talk about patient teaching. Teaching demands feedback that is more than just having the patient shake their head and say they understand. The patient needs to verbalize understanding or state back to you in their own words what you have taught them.

I am pleased to say that later I interpreted for our Diabetes Nurse Educator for a Mexican man who had come to the ER in diabetic ketoacidosis. I made sure he had PICTURE charts of appropriate foods and amounts (tortillas, salsa, fish, avoiding deep fried and greasy foods...) The thing with being illiterate in reading is that they are probably mathematically illiterate as well. They don't know their numbers, they don't know that 185 is greater than 158. So basic to us, so difficult for them. We spent hours with him on learning to draw up insulin and check blood sugars and understanding what the numbers meant. Hours making sure he had access to insulin and syringes through a pharmacy. Patient teaching is not something that can be accomplished in 5 minutes just before discharge.

Home Health Columnist / Guide · Mar 14, 2006

Patient teaching is not something that can be accomplished in 5 minutes just before discharge.

:yeahthat:

Priceless advice.

:thankya: :thankya: :thankya:

franlondon · Mar 14, 2006

Hello all,
I recently realized one of my dialysis patients couldn't read. I was surprised. Can anyone direct me to educational material for those who can't read. I need dietary information the most.
Also, can anyone direct me to research or papers written on the subject of an adult who can't read. I would like to write a journal article on the subject.
Thanks in advance for your help

You might want to review the resources available before writing your own. Here are a few of the best:

AMC Cancer Research Center. (1994). Beyond the brochure: Alternative approaches to effective health communication. Retrieved October 10, 2005, from http://www.cdc.gov/cancer/nbccedp/bccpdfs/amcbeyon.pdf

Atkinson, T. (2003). Plain language and patient education: A summary of current research. Retrieved 11/2, 2005, from http://www.centreforliteracy.qc.ca/health/briefs/no1/1.htm

Berkman, N. D., DeWalt, D. A., Pignone, M. P., Sheridan, S. L., Lohr, K. N., Lux, L., et al. (2004). Literacy and health outcomes. Evidence report/technology assessment no. 87 (No. AHRQ Publication No. 04-E007-2). Rockville, MD: Agency for Healthcare Research and Quality.

Dreger, V., & Tremback, T. (2002). Optimize patient health by treating literacy and language barriers. AORN Journal, 75(2), 278, 280-273, 285, 287, 289-293, 297-300, 303-304.

How to write easy to read health materials. (2005, November 21, 2005). Retrieved 1/15, 2006, from http://www.nlm.nih.gov/medlineplus/etr.html

National Cancer Institute. (1994, 2/27/03). Clear & simple: Developing effective print materials for low-literate readers. Retrieved 1/15, 2006, from oc.nci.nih.gov/services/Clear_and_Simple/HOME.HTM

National Center for Education Statistics (NCES). (2005). 2003 national assessment of adult literacy (naal). Retrieved 1/15, 2006, from http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006471

Rudd, R. E., Moeykens, B. A., & Colton, T. C. (1999). Chapter five: Health and literacy: A review of medical and public health literature. In J. Comings, B. Garners & C. Smith (Eds.), Health and literacy. NY: Jossey-Bass.

Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., et al. (2003). Closing the loop: Physician communication with diabetic patients who have low literacy. Archives of Internal Medicine, 163, 83-90.

Schultz, M. (2002). Low literacy skills needn't hinder care. RN, 65(4), 45-48.

Weiss, B. D. (2003). Health literacy: A Manual for clinicians: American Medical Association Foundation and American Medical Association.

Williams, M. V., Davis, T., Parker, R. M., & Weiss, B. D. (2002). The role of health literacy in patient-physician communications. Family Medicine, 34(5), 383-389.

- Fran London, MS, RN

Health Education Specialist

Phoenix Children's Hospital

RNMISTY362b · Mar 15, 2006

Try PECS picture exchange communication. Speech therapist can help you with this or contact special education dept with your local school district. These are picture used in place of word to allow reading or speech for non verbal people. These also work great for Pt whom have had strokes. I hope this is helpful.